Dilemma of countering happy hypoxaemia COVID-19 patients- BM
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Some patients with COVID-19 experience low oxygen levels without dyspnea. This paradoxical ‘happy hypoxemia’ has baffled both physicians and patients. Authors report on one striking case that illustrates the marked difference that can be present between the respiratory symptoms experienced by the patient and objective signs of hypoxemia and pulmonary disease. This paradox creates a management challenge.

A 65-year-old man who was an ex-smoker was hospitalized after testing positive for SARS-CoV-2 on PCR. He had experienced a fever for 2 days but was asymptomatic on admission, despite having an oxygen saturation of 86% in room air (oxygen therapy targeted SpO2 more than 94%). Oxygen therapy was started from 2 L/min. Chest CT revealed mild bilateral pneumonitis in the lower lung lobes, but no signs of pneumonitis in the upper lobes. He was treated with oxygen, dexamethasone, favipiravir and low-molecular-weight heparin.

Despite receiving treatment, his oxygen level worsened gradually, and he required supplemental oxygen at a flow of 4 L/min. His CT on day 3 revealed ground glass opacities (GGO) in the upper lung lobes. Thus, remdesivir and tocilizumab were added to his treatment. His CT on day 10 revealed that the GGO had transitioned to organizing pneumonia. He remained unaware of his poor clinical condition and demanded to be discharged. His physicians agreed to discharge him on home oxygen therapy the following day.

However, the following morning, his hypoxemia had started to improve and he agreed to remained hospitalized. His oxygen level steadily improved and the supplemental oxygen was stopped on day 15. A repeat chest CT revealed that the organizing pneumonia had regressed.

This case illustrates that some COVID-19 patients with happy hypoxemia can recover rapidly. Physicians should encourage such patients to remain hospitalized and should monitor them closely if they are discharged early, in order to prevent excessive use of oxygen therapy.

Source: https://casereports.bmj.com/content/14/2/e241588?rss=1